The Obesity Epidemic — Is Medicine Scientific?

An anonymous reader writes "An award-winning science author, Gary Taubes, has written a book that pans the medical community's treatment of the obesity epidemic. What is interesting is that it looks like the medical community is behaving in a very unscientific manner. Taubes points out that the current medical orthodoxy — that consuming fat makes you fat and exercise makes you thin — has no basis in research. In fact, all the available research points in quite another, and more traditional, direction. Here's the (excellent) podcast of an interview with Taubes on CBC's 'Quirks and Quarks.' So, has medicine become a non-science? Is it mostly a non-science? Somewhat?"

Comments

Taubes is a quack.

[morgan_greywolf]

From personal, scientifically-measurable experience, I can tell you that gaining and losing weight isn't a matter of 'good calories' or 'bad calories'. It's a matter of calories. Burn more calories than you consume over a period of time, and you will lose weight. Burn fewer calories than you consume over a period of time, and you will gain weight. Yes, it's that simple. I suggest you all put down this claptrap, and read The Hacker's Diet by former AutoCAD developer and AutoDesk VP John Walker. It's done wonders for me.

Nutrition, yes. Exercise, no.

[curunir]

When it comes to the current thinking on nutrition, there is a definite point to what he's saying.

But to say that Exercise has no effect on weight loss is just plain wrong. Exercise changes the way your body processes the food you put into it (or, more accurately, your body adapts to the amount of exercise that you get). Building muscle causes you to require more calories in your diet to support that muscle. And building stamina causes you to burn a lot of calories in the process. And if you want to venture into the unscientific realm, consistent exercise helps to stabilize your mood and makes you less prone to food cravings (the cravings for sugary foods and for fatty foods are based in imbalances in Serotonin and Dopamine levels).

There is a dire need to re-examine everything we know about a healthy diet. People get so worked up about things like trans fats while completely ignoring the elephant in the room (high-fructose corn syrup). Everyone I know who's given up corn syrup, to the extent that it's possible in the US, has lost a minimum of 10 lbs.

But to suggest that exercise isn't a vital part of a healthy lifestyle is wrong, and potentially very dangerous.

More olive oil, more cream-- less weight

[Maxo-Texas]

I lost 25 pounds after I simply cut out bread, potatoes, and sugar from my diet.

In the mean time, I added a gallon of olive oil every 60 days and a pint of cream a week.

Tho fit already (sports twice a week, regular walking and exercise) I started developing diabetes (of course my mom and grandparents had it so I'm kinda doomed there). Despite cutting out enormous amounts of carbs and sugars (I was previously drinking 1,000 calories of soda a day), I continue to slide in the bad direction on my blood sugar. It's not diabetic yet but it is just a matter of time.

My diet consists of large amounts of vegetables, meat courses, almost no grains (2-3 ounces a day tops).

I think people have different needs based on their genetic history.

I agree that a lot of "science" these days is opinion, hysteria, or someone's hidden agenda.

He May Be But You're Not Helping

[eldavojohn]

It's done wonders for me. I think that's the number one problem with diet plans these days. People assume that since it worked for them it will work for everyone else. I don't think that's the case.

To answer the questions of the summary, I don't think it will ever be an untainted science so long as the government, businesses & religion stick their noses in it. Couple that with the difficulty of applying the scientific method to humans (average life span of 75 years and ethical problems) and I think you'll see why medicine is a 'non-science.'

Patents, legislation & belief in what is good for you are what ruin medicine. Look at all the Hindu medicine that was ignored by the West for the longest time because it was ... well, Hindu.

Medicine will continue to be a non-science no matter how hard the community tries. The public's assumptions and beliefs that "Since I can eat McDonald's every day and be thin, everyone should be able to" merely exacerbates the situation.

I eat whatever I feel like and I'm in great shape. This is not the case with the majority of Americans.

Perhaps it's worth investigating...

[Spy der Mann]

Not more of this low-carb propaganda bullshit.

I understand your anger, but the issue here is whether the low-carb propaganda is really bullshit or not. It is a matter that should be investigated, otherwise those dismissing it as bullshit would effectively act as anti-low-carb zealots, instead of following the scientific method.

Also, we have to wonder why the US (the country where the Food Pyramid originated) is also where the "fatness" phenomenon originated, and why the countries that start to follow the "american way of life" (fast food, sedentary life, high-calory carb snacks) tend to follow american's fatness. This phenomenon, at least country-wise, behaves like an epidemic.

Re:Perhaps it's worth investigating...

[badasscat]

I understand your anger, but the issue here is whether the low-carb propaganda is really bullshit or not. It is a matter that should be investigated, otherwise those dismissing it as bullshit would effectively act as anti-low-carb zealots, instead of following the scientific method.

Ok, here's your scientific study:

Asians eat carbs with almost every meal (rice, noodles). They are thinner than us. End of story.

Excess calories make you fat. That's a law of physics; I have no idea why some people dispute it. It's like arguing with the law of gravity. The only question is whether calories coming from different sources are absorbed more slowly or quickly, but the end result is the same unless you're exercising to stay in shape. A calorie is a unit of energy and if that energy is not used, it must be stored. Energy doesn't just disappear into thin air; when you consume it, you either use it or you store it.

And I really don't think there are any scientists out there saying otherwise; I don't know of any scientist saying "eating fat makes you fat" or even "eating carbs makes you fat". The only time that's ever said is in the context of certain types of high-fat or high-carb foods generally being higher in calories, which is true. Although again, Asians eat plenty of fatty meats along with their carbs and they're still thinner than we are. The reason is they just eat less. Which means fewer calories.

Not rocket science. And we've got all the knowledge we need.

Re:Perhaps it's worth investigating...

[cbr2702]

"Excess calories make you fat. That's a law of physics; I have no idea why some people dispute it. It's like arguing with the law of gravity. The only question is whether calories coming from different sources are absorbed more slowly or quickly, but the end result is the same unless you're exercising to stay in shape. A calorie is a unit of energy and if that energy is not used, it must be stored. Energy doesn't just disappear into thin air; when you consume it, you either use it or you store it."

This would require human waste to have no caloric value.

Re:Perhaps it's worth investigating...

[Shinmizu]

This would require human waste to have no caloric value.
Ooh, I smell a new diet fad coming.

Re:Perhaps it's worth investigating...

[sitarah]

"Calories in, calories out. It's so easy!" You are missing the point and the reason all these low-carb, low-fat, low-whatever suggestions exist. Calories in, calories out works in a lab environment where you can measure intake, consumption methods, and waste precisely. You cannot do that with humans. There are too many variables.

1) You don't know what your calories out are.

You have no idea what you are really burning, standing around, unless you get a battery of tests performed to check your metabolism, lung function, and body heat during any given activity.

There are a ton of things that affect your metabolic rate; your core temperature, insulin levels, sugar sensitivity, allergies, your inclination to fidget, whether you are building muscle at a given time, whether you are healing wounds or recovering from sickness. There has even been researching suggesting that 3 months of consistent exercise actually changes your energy consumption at a mitochondrial level. Did you know soy and broccoli reduce the level of iodine in your body and therefore inhibit metabolic function?

2) You don't know what your calories in are.

You know what the government knows about broccoli: that if you light it on fire, it burns at x rate, and it leaves behind x waste. They extrapolate its structure from there. That has nothing to do with how well your body actually digests the food and uses that energy. You could have an extremely acidic stomach, or lock up calories with excess fiber, or drink too much and hurry food through your intestinal track before you can extract all its energy.

You also don't know how well-marbled their test steak was, how saturated with water their chicken breast was (did you know supermarket chicken is injected with saltwater?), or how aerated their whipped cream was. This will all lead to a difference in caloric value. These little differences all add up.

These diet plans that discard certain foods do so with the idea that we might be able to find a diet that works by minimizing a variable; eat fewer carbs to reduce insulin levels, isolate sugar sensitivity, eat less wheat to minimize allergies, eat less meat to reduce hormones, salt, and saturated fat, etc.

Asians are genetically different; they have different musculatures (they might have smaller thighs, for instance, meaning they burn less calories because that's a very large muscle group), different insulin levels, they may produce heat differently than Europeans due to their environment. There's also cultural differences; less dairy, more lean meat, etc. You're just not making an apples to apples comparison.

Just finished Taubes' book this morning

[phunctor]

He makes the extraordinary claim that Official Nutrition has been getting it wrong for the last 40 years. However, he provides and discusses a solid body of relevant and eminently respectable (Lancet, JAMA, NEJM, etc..) citations to support his claim. Color me 95% convinced.

He notes that the application of the first law of thermodynamics (the slogan is "A Calorie is A Calorie") to a homeostatic dissipative system like the human body is beyond simplistic. It is simply wrong.

The core of his thesis is that a cellular-level metabolic disorder caused over time by consumption of concentrated and rapidly available carbohydrates, and the insulin spikes they provoke, is the cause not only of obesity but also of type II diabetes. Briefly, fat cells become too good at extracting glucose from the blood and storing it. This results in cellular-level semi-starvation in other body tissues, expressed at the organismic level by eating more and exercising less.

He depicts the high level of investment in the competing "gluttony & sloth" model of obesity which exists in our medical establishment and in our culture. Indeed, from his portrayal this viewpoint is very close to being an ideology rather than a theory, in that dissenters are cast into outer darkness rather than refuted.

He discusses the personalities and politics involved in the alleged disastrous wrong turn, and points up some interesting coincidences involving what research gets funded, and what research doesn't get funded, by for example sugar producers.

I'm intentionally being very brief. If you have a personal stake, read this book and form your own conclusions.

--
phunctor

Yes and no.

[Valdrax]

Calories make you fat, regardless of whether they come from fat, sugars, or starches.

This is absolutely true. You can't dispute the fact of this statement taken in isolation. In isolation.

However, it's a fine example of blinding yourself to the causes. The questions at the heart of the debate between low-carb and low-fat diet proponents are the following:

1. Does eating certain types of food allow for the intake of more calories before being satisfied? (e.g. Pork vs. chicken; fruit vs. Twinkies)
   
2. Do certain foods increase hunger? (i.e. Effects on insulin and other hormones)
   
3. Do certain foods have other health issues than weight? (e.g. Saturated vs. unsaturated fat; sugar-intake & diabetes.)
   

So just saying calories are calories is like saying BTUs are BTUs and putting heating oil in your gas tank in the hopes of getting better MPG.

Advice on nutrition from the 1970s

[cartman]

The recommended advice of replacing fats with carbohydrates was repeated so often and so forcefully by everyone, that it's now printed on the back of almost every box of food in the country, in the form of the "USDA food pyramid". It was so often repeated that when I was a child (in the 1970s) things like wonder bread with a bit of margarine were considered health foods (lots of carbs, no saturated fat).

I had always assumed that the medical community had done large-scale long-term studies demonstrating that such a diet led to an increase in lifespan, a reduction in disease, and a loss of unhealthy pounds. Apparently, such studies were never done.

But then the massive Harvard Nurses Heatlh Study was performed, ending in the mid-1990s. In that study, researchers followed 40,000 nurses for decades, in what was the largest and most comprehensive study on human nutrition ever. The study found that replacing fats with carbohydrates had absolutely no effect on longevity or disease. Furthermore, replacing butter with margarine (the standard dietary advice for decades) led to no benefit either. IIRC, the only nurses who lived longer and had less disease were those who ate nutrient-dense monounsaturated fats like almonds and cashews.

As a result of the Harvard Nurses Health Study, researchers in nutrition quietly dropped their assumptions about dietary fats causing disease.

I still can't believe it. The standard dietary advice from 1960 to 1990 must have been the single largest pseudoscientific load of crap in modern history. What a colossal embarrassment. If the USDA publicly admits that it was mistaken then it will be a long time before people trust it again.

Re:Ugh...

[NeutronCowboy]

You're like every customer who calls into customer support: they know the symptoms, are vaguely aware of the underpinnings of the machine and are absolutely convinced they know what the issue is.

Do yourself a favor, and treat your next interaction with your doctor like a call with tech support: understand that they know more about how the system is supposed to work than you, understand that you know more about how your system works than them, transfer that knowledge to them, and be patient while they wade through the standard troubleshooting steps (did you reboot your machine? do you get enough sleep/vitamins?).

You'll actually have a chance of getting some use out of them, and live a better life.

after having read the majority....

[russ1337]

After having read the majority of the threads it seems that everyone on Slashdot thinks they are a nutritional expert. Somehow I don't think that is the case.

Re:Ugh...

[cbr2702]

"If you eat like a predator, you'll have a body like a predator. If you eat like a herbivore, you'll look like one."

Why only eating? Why not acting? Chase down those animals yourself (with no tools); that'll improve your body.

My best trainer sold it to me like this:

[rickb928]

1. Muscle must be fed. Fat doesn't. Strength training builds muscle, which if nothing else consumes calories all the time, just much less at rest.

2. What goes in must either be used or go out. If I eat 6 pounds of food a week, and manage to consume 3 pounds of that as energy, eliminating 3 pounds as indegestible waste (you know what I mean), I neither gain or lose. If I work harder, or replace fat with muscle, I need more energy. It comes from somewhere.

3. If I eat less, I will eventually lose weight. The key word is 'eventually'.

4. If I work more, and don't change my diet, I will eventually lose weight.

5. The equation is, eat less, work more, and be patient. My body may well try to hoard resources in response to the apparent famine or starvation of not so much food.

6. Keep a balanced diet. Not feeding your body nutrients, especially calcium and trace elements, is very bad.

7. Portion control. Just do it.

8. Keep at it. Patience.

9. Drink plenty of water.

10. Read items 1-9 regularly and heed.

Re:Ugh...

[PCM2]

The law of conservation of energy is sufficient to result in that blanket statement.

Sure... provided you have no real understanding of the processes involved.

The common, simplistic explanation of nutrition is that you consume food, which your body then breaks down, releasing the energy of chemical bonds, which your body then uses as fuel. We measure the energy released in a unit called calories.

This description is fine, and it suffices for most day-to-day discussions of food, with one caveat: It's fiction, almost from top to bottom.

Just for starters, when nutritionists talk about calories, they're not really talking about calories like a physicist would. They're really talking about "food calories," which I believe are equivalent to kilocalories. This may be a minor point, but it serves to illustrate that if you think nutrition science maps directly onto physics, you are wrong.

Second, and more importantly, any good college chemistry instructor will tell you that the body does not "release energy" from the chemical bonds in food. Chemicals form bonds because the bonded compounds are the lowest-energy state for those particles. In other words, it takes energy to break a chemical bond, not the other way around. Digestion allows us to extract energy from food because we break down certain chemical bonds and cause those chemicals to form other, different bonds -- bonds with an even lower energy state than the original form. Our bodies can then take advantage of the surplus (and exactly how is still another story).

If you understand this, it should be obvious that digestion can be a fairly complex process, not all food is equal, and you can't measure the "calories" in a food as if you had a gas gauge.

Re:Ugh...

[eln]

As for being fat. If you eat like a predator, you'll have a body like a predator. If you eat like a herbivore, you'll look like one. You're right. I eat just like a predator, meaning I hunt for days to find food, then chase it down for 2 hours before I finally catch it. Then, I tear through it with my pointed teeth and razor sharp claws, eating as much as possible while trying to fend off predators. As a result, I have a svelte physique and a thick, glossy coat.

Medicine was never a 'hard' science

[schweini]

My girlfriend happens to be a doctor, and currently works in a 'obesity clinic', and she is going for a PhD in public health, with a focus on obesity, and she left me with the impression that:
- Real medicine never was a 'real' science. It's absolutely shocking how many publications, treatments and diagnosis are based purely on 'gut feelings', or incoherent theories. Just pull up any statistics on malpractices, and be shocked. No other 'science' could get away with so many errors, after such a long time of experimenting. This happens in part because medicine is a rather unique applied science: there're a lot of psychological factors, and incredible amount of measuring errors, a gigantic level of complexity and tons of historic 'baggage' that doctors have to face every day.
- Medicine is getting a lot better in this aspect - there seems to be a relatively new way of thinking (in the medical community, at least) called "Evidence based medicine", which, if i understood correctly, could be basically summed up as applying scientific principals to the medical processes
- Obesity in specific is extremely complex. Almost everything you do has some influence on you body-weight and composition. Of course the laws of thermodynamics apply to human beings, too, but there are a gazillion factors that influence just how exactly the body deals with excessive calorie intake, or lack thereof, ranging from genetical to psychological and social factors. Just a basic example would be that if you simply stop eating for a week, you usually lose LESS weight compared to if you start 'snacking' all the time, eating 5 little meals a day (basic theory behind this sems to be that the body switches to 'emergency mode' if there's no food around, trying to save as may energy reserves as it can)
- Most theories seem to me to be a wild mixture of anecdotal observations mixed with biochemistry, somehow resembling Freudian theories - they are coherent in them selves, but lack a level of 'scientific interconection' to other knowledges. So it's quite common for a specific theory in obesity to me contradictory to a theory of e.g. neuroscience. As long as both theories "kind of" work, it doesn't seem to be a top priority to resolve that discrepancy (in contrast to what i have observed in 'hard sciences'). AS far as I can tell, thee's no real proof or reason why Whiskey shouldn't be as bad as Vodka in a diet, yet (here, at least) it's common knowledge that whiskey's ok, but vodka will make you fat - and as long as this works, it doesnt matter that much why this happens, or if it happens at all.

Re:Ugh...

[BenBoy]

Scares the hell out of the cat, though...